ALBUQUERQUE, N.M. — This summer, the State of New Mexico froze Medicaid payments to mental health providers because of fraud allegations. That left 30,000 mental health patients struggling to find new medical homes, and 15 New Mexico providers in the hands of five Arizona companies.
However the partial release of an audit of those agencies paid for by the state raises more questions about the takeover.
When the New Mexico Human Services Department froze Medicaid payments to providers in the state, the reason they gave was "credible allegations of fraud." From there, the 15 agencies were taken over by five Arizona companies, and the allegations were turned over to authorities to investigate.
One source of information the state used to make their decision was an audit conducted by an out-of-state company called PCG. Now, a partial release of that audit reveals that PCG's "Case File Audit did not uncover what it would consider to be credible allegations of fraud."
Only 58 pages of the 400 page audit were released, and many of the released pages remain heavily redacted. However, the Human Services Department says other sources of information were used to arrive at their decision to transition the New Mexico firms to Arizona control. HSD also said the FBI, US Attorney and state Attorney General are all investigating the matter.
New Mexico Attorney General Gary King said his office will continue to investigate HSD's claim before any criminal charges are filed, but adds there is no solid timeline as to when a final determination will be made.